Economic evaluation of palivizumab in children with congenital heart disease: a Canadian perspective

Can J Cardiol. 2011 Jul-Aug;27(4):523.e11-5. doi: 10.1016/j.cjca.2010.12.064. Epub 2011 Jun 12.
[Article in English, French]


Background: Respiratory syncytial virus (RSV) is a common cause of bronchiolitis in infants. In children with congenital heart disease (CHD), it is associated with significant morbidity and mortality. Palivizumab is a monoclonal antibody that reduces the number of RSV-associated hospitalizations in children with CHD. We sought to assess cost savings and cost-effectiveness of palivizumab in children < 2 years old with hemodynamically significant CHD in a provincially administered RSV prophylaxis program.

Methods: A cohort of children who received palivizumab (N = 292) from 2003-2007 was compared to a historical cohort of children (N = 412) from 1998-2003 who met the eligibility criteria for palivizumab prior to initiation of the prophylaxis program. Direct and indirect costs and benefits were determined.

Results: The direct and indirect costs in the historical cohort were $838 per patient season compared to $9130 per patient season in the palivizumab cohort. Risk of admission was reduced by 42%, and days in hospital were reduced by 83%. The incremental cost of the RSV prophylaxis program was $8292 per patient for 1 RSV season. The incremental cost to prevent 1 day of hospitalization was $15,514. The cost of palivizumab accounted for 87.9% of the cost of prophylaxis.

Conclusions: Palivizumab is clinically effective; however, the cost was exceptionally high relative to the outcomes in this population. Given the financial constraints in a public health care setting, more strict criteria for patient selection or reduced drug costs would improve the cost-effectiveness of RSV prophylaxis.

MeSH terms

  • Antibodies, Monoclonal / economics*
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • British Columbia
  • Bronchiolitis / prevention & control*
  • Bronchiolitis / virology
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / drug therapy*
  • Humans
  • Infant
  • Palivizumab
  • Respiratory Syncytial Virus Infections / prevention & control*
  • Respiratory Syncytial Virus Infections / virology


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Palivizumab